March 05, 2021

Texas Providers Do Not Have Private Right of Action Regarding Payment for Emergency Services

On February 23, the Court of Appeals for the Fifth District of Texas (Dallas) ruled that providers do not have a private right of action under the state’s emergency care statute to challenge a payor’s determination of the appropriate UCR rate. Considering the text of this section of the Texas Insurance Code, the legal standard applicable to legislative intent to create private rights of action, and the legislative history of the law, the court concluded the statute did not create a private right of action in favor of non-network physicians or providers. The United States District Court for the Northern District of Texas has recently reached a similar conclusion.

The Court also rejected plaintiffs’ theory of unfair settlement practices as assignees, holding that claims under Chapter 541 of the Texas Insurance Code may not be assigned. Finally, the court dismissed the remaining quantum meruit and declaratory judgment claims, determining these alternative claims for relief cannot indirectly provide the relief requested pursuant to Texas Insurance Code.